3900-FM-BSDW0130
Rev. 5/2013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
Safe Drinking Water Act SDWA-5
Monthly Filter Plant Performance
I.
General Plant Information
PWS Name:
Address:
Phone:
1
2
PWSID
3
Trans
4
Filter Plant
ID#
Report Month
Name
MMYY
09
II.
5
Combined Filter Effluent Turbidity (All filtered systems)
Plant Operation Hours
Combined Filter Effluent Turbidity
6A
6B
Number of
Measurements
Filter (Plant) Type Codes
C = Conventional
D = Direct
M = Membrane
S = Slow sand
E = DE
O = Other
III.
8
Number of Results
Meeting PLR
7Plant
Performance Level (xx.x%)
6B X 100
6A
=
.%
Turbidity Performance Level Requirements (NTUs)
<0.3 for C, D, M, or O
<1.0 for S or E
Combined Filter Effluent Turbidity Exceedance Reporting (All filtered systems)
Did any results exceed the maximum allowable turbidity level?
Yes
No
Maximum Allowable Turbidity (NTUs)
1 for C, D, M, or O
2.0 for S or E
For the month, you must report all combined filter effluent (CFE) turbidity measurements that exceeded the maximum
allowable turbidity level on an SDWA-1 form. (See SDWA-1 instructions for reporting CFE turbidity measurements.)
IV.
9.
Individual Filter Turbidity (Conventional or direct filters only)
Was individual filter monitoring conducted continuously on all operating filters during the month, and were the results
recorded at least every 15 minutes?
Yes (Go directly to Section V)
No (Proceed to question #10)
10.
Was continuous monitoring or recording interrupted on any filter due to a failure in equipment?
Yes (Proceed to question #11)
No (Go directly to Section V)
11.
Did you conduct grab sampling or manual recording every 4 hours in lieu of continuous monitoring or recording for a
period not exceeding 5 working days (for PWSs serving > 10,000) or 14 days (for PWSs serving < 10,000) following
failure of equipment?
Yes
No
V.
Individual Filter Turbidity Exceedance Reporting (Conventional or direct filters only)
12.
Did any individual filter measurements exceed trigger level #1 or trigger level #2?
Yes
No
Trigger Level #1. Turbidity >1.0 NTU in 2 consecutive 15 minute measurements.
Trigger Level #2. Turbidity >0.5 NTU in 2 consecutive 15 minute measurements 4 hours after filter returned to service.
For the month, you must report all individual filter turbidity measurements that exceeded either of the trigger levels for
any of the individual filters in this plant, regardless of the reason. Record all measurements on an SDWA-1 form. (See
SDWA-1 instructions for reporting individual filter turbidity measurements.
Please see the reverse side
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3900-FM-BSDW0130
Rev. 5/2013
VI.
LT2ESWTR Reporting (All systems with filtration)
13.
What was the highest Bin source used during the month?
Bin 1
Bin 2
Bin 3
Bin 4
*(Bin 4 includes any unclassified SW or GUDI source used during the month)




If Bin 1 using only C, D, S, E or O filtration, go to Section X.
If Bin 2 or higher using C or D filtration, go to section VII.
If Bin 2 or higher and using S, E, or O filtration, go to Section IX.
If using M filtration, (all Bin #s), go to Section VIII.
VII. CFE & IFE Performance Option – C or D filtration using Bin 2 or higher
14.
15.
Was the CFE turbidity < 0.15 NTU in at least 95% of the measurements for the month?
Yes
No
Was the IFE turbidity < 0.15 NTU in at least 95% of the measurements for the month?
Yes
No
16.
Was the IFE turbidity > 0.3 NTU in two consecutive measurements taken 15 minutes apart during the month?
Yes
No
Systems with C filtration using Bin 2 source only: If the answer is "Yes" to Q14 & 15 and "No" to Q16 go to Section x. All
others, go to Section IX.
VIII. Membrane Filtration Integrity Testing
17.
18.
Did a Membrane Filtration Indirect Integrity Test Exceedance occur during the month?
Yes
No
Did a Membrane Filtration Direct Integrity Test Exceedance occur during the month?
Yes
No
If the answer to either question is "YES", go to Section IX. All other systems, go to Section X.
IX.
Microbial Toolbox Monthly Operational Report, Form #3900-FM-BSDW0517
Complete the LT2ESWTR Monthly Operational Report (MOR) and submit it to the appropriate DEP Regional Office if
any of the following conditions were met for the month:




PWS with C filtration not meeting CFE & IFE Performance criteria in Section VII,
PWS with M filtration using any Bin source and answering "Yes" to Q17 or Q18,
PWS with D, S, E, or O filtration using a Bin 2, Bin 3 or Bin 4 source,
PWS with C filtration using a Bin 3 or Bin 4 source.
X.
Verification
By signing this form you are certifying that the information contained herein is true and accurate.
Approved by:
Date:
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